Evaluation of carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease

ObjectiveTo assess the carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease.Material and methodsObservational, cross-sectional study carried out at the Universidade Federal de São Paulo (chronic kidney disease outpatient clinics) with 55 patients (60% males) with a median age of 11.9 years (I25–I75: 9.2–14.8 years). Of the 55 patients, 43 were on conservative treatment and 12 were on dialysis. Serum laboratory parameters (creatinine, uric acid, C-reactive protein, total cholesterol and fractions, and triglycerides), nutritional status (z-score of body mass index, z-score of height/age), body fat (fat percentage and waist circumference), and blood pressure levels were evaluated. The carotid intima-media thickness measure was evaluated by a single ultrasonographer and compared with percentiles established according to gender and height. Data collection was performed between May 2015 and March 2016.ResultsOf the children and adolescents with chronic kidney disease, 74.5% (95% CI: 61.0; 85.3) showed an increase (>P95) in carotid intima-media thickness. In patients with stages I and II hypertension, 90.9% had increased carotid intima-media thickness. Nutritional status, body fat and laboratory tests were not associated with increased carotid intima-media thickness. After multivariate adjustment, only puberty (PR = 1.30, p = 0.037) and stages I and II arterial hypertension (PR = 1.42, p = 0.011) were independently associated with carotid intima-media thickness alterations.ConclusionThe prevalence of increased carotid thickness was high in children and adolescents with chronic kidney disease. Puberty and arterial hypertension were independently associated with increased carotid intima-media thickness.     

Physical fitness and activity,metabolic profile,adipokines and endothelial function in children

ObjectivesThe prevalence of obesity is increasing. The aim of this study was to investigate if there is endothelial dysfunction in children with normal or excess weight, and whether the metabolic profile, adipokines, and endothelial dysfunction would be more strongly associated with physical fitness or with physical activity levels.MethodCross-sectional study involving children aged 5–12 years. The evaluation included venous occlusion plethysmography, serum levels of adiponectin, leptin and insulin, lipid profile, physical activity score (PAQ-C questionnaire), and physical fitness evaluation (Yo-Yo test).ResultsA total of 62 children participated in this study. Based on the body mass index, 27 were eutrophic, 10 overweight and 25 obese. Triglycerides, LDL cholesterol, HOMA-IR, and leptin were higher in the obese and excess-weight groups compared to the eutrophic group (p < 0.01). HDL cholesterol and adiponectin levels were higher in the eutrophic group compared to the obese and excess-weight groups (p < 0.01). Flow-mediated vasodilation after hyperemia was higher in the eutrophic group in comparison to obese and excess-weight subjects (p < 0.05). There was no difference in the physical activity levels among groups measured by PAQ-C. The Yo-Yo test was significantly associated with HDL cholesterol (rho = −0.41; p = 0.01), and this association remained after adjusting for body mass index z-score (rho = 0.28; p = 0.03).ConclusionThis study showed that endothelial dysfunction is already present in obese children, suggesting a predisposition to atherosclerotic disease. Moreover, HDL cholesterol levels were correlated with physical fitness, regardless of body mass index.     

Predictive factors of recurrence after pediatric acute pericarditis

ObjectiveThe predisposing factors for pericarditis recurrence in the pediatric population have not yet been established. This study aimed to define the risk factors for the unfavorable prognosis of pediatric acute pericarditis.MethodsThis was a retrospective study that included all patients with acute pericarditis treated from 2011 to 2019 at a tertiary referent pediatric center.ResultsThe study included 72 children. Recurrence was observed in 22.2% patients. Independent risk factors for recurrence were: erythrocyte sedimentation rate ≥ 50 mm/h (p = 0.003, OR 186.3), absence of myocarditis (p = 0.05, OR 15.2), C-reactive protein ≥ 125 mg/L (p = 0.04, OR 1.5), and non-idiopathic etiology pericarditis (p = 0.003, OR 1.3). Corticosteroid treatment in acute pericarditis was associated with a higher recurrence rate than treatment with non-steroid anti-inflammatory therapy (p = 0.04). Furthermore, patients treated with colchicine in the primary recurrence had lower recurrence rate and median number of repeated infections than those treated without colchicine (p = 0.04; p = 0.007, respectively).ConclusionIndependent risk factors for recurrence are absence of myocarditis, non-idiopathic etiology pericarditis, C-reactive protein ≥ 125 mg/L, and erythrocyte sedimentation rate ≥ 50 mm/h. Acute pericarditis should be treated with non-steroid anti-inflammatory therapy. A combination of colchicine and non-steroid anti-inflammatory drugs could be recommended as the treatment of choice in recurrent pericarditis.     

States of serum leptin and insulin in children with epilepsy: Risk predictors of weight gain

Background and objectivesWeight gain is an adverse metabolic effect in some children with epilepsy. The studies done to detect the effect of antiepileptic drugs and weight homeostatic hormones, insulin and leptin, were limited and controversial.Materials and methodsWe evaluated the serum leptin and insulin as predictors of weight gain in children receiving long-term treatment with valproate (VPA), carbamazepine (CBZ), lamotrigine (LTG). This study included 90 patients (treated: 70; untreated: 20). Serum lipid profile, insulin and leptin were measured.ResultsBMI, serum leptin and insulin were significantly elevated in VPA compared with controls, untreated patients and those treated with CBZ, LTG and combined therapy with LTG. Girls on VPA had higher BMI and leptin levels than boys. With VPA, serum insulin was correlated with BMI (r = 0.625, p < 0.01), leptin (r = 0.823, p < 0.001), treatment duration (r = 0.775, p < 0.01) and VPA dose (r = 0.975, p < 0.0001). Serum leptin was correlated with age (r = 0.980, p < 0.0001), BMI (r = 0.704, p < 0.01), serum insulin (r = 0.823, p < 0.001), LDL-c (r = 0.630, p < 0.01), HDL-c (r = ?0.880, p < 0.001), treatment duration (r = 0.770, p < 0.01) and VPA dose (r = 0.970, p < 0.001). BMI is correlated with serum insulin, leptin, LDL-c (r = 0.835, p < 0.001) and HDL-c (r = ?0.955, p < 0.0001).ConclusionHyperinsulinemia and hyperleptinemia are common with VPA and marked among epileptic children who gained weight suggesting states of insulin and leptin resistances. These alterations were not demonstrated with CBZ or LTG. The relationship between VPA, leptin and weight seems to be gender specific. Serum leptin may serve as a sensitive parameter for weight gain and reduction with intervention programs during follow-up of girls with epilepsy.     

Immunoexpression of adrenergic receptors in detrusor from patients with prune belly syndrome: a digital quantification

IntroductionPrune belly syndrome (PBS) presents with large-capacity bladders, high compliance and post-void residual volumes. Operative and conservative treatments are controversial. When histologically compared to normal bladder, bladder outlet obstruction results in an up- or down-regulation of adrenoceptors. Our goal was to study the immunoexpression of adrenoceptors in detrusor from patients with PBS.Materials and methodsBladder domes from PBS patients (n = 14) were studied (PBG). For normal controls, bladder specimens were obtained at adult surgery (n = 13) (CG1) and at child autopsy (n = 5) (CG2). Staining was performed using antibodies to α1a, α1b, α1d and β3 adrenoceptors. Five to 10 images were captured on an optic microscope with a digital camera and analysed with Photoshop®. The immunocyhistochemical index with arbitrary units was calculated and compared.ResultsMean age was 1.28, 64 and 1.41 years for PBG, CG1 and CG2, respectively. The immunohistochemical index with arbitrary units of α1a receptors was 0.06 in PBG, 0.16 in CG1 and 0.14 in CG2 (p = 0.008); of α1b 0.06, 0.06 and 0.07 (p = 0.781); and of α1d 0.04, 0.04 and 0.05 (p = 0.618). Regarding β3 the respective values were 0.07, 0.14 and 0.10 (p = 0.378).ConclusionOur results show a decrease in α1a-adrenoceptor immunostaining intensity in detrusor from children with PBS. Further in vitro studies are needed to determine whether these observations are physiologically significant.     

Can MII–pH values predict the duration of treatment for GERD in preterm infants?

BackgroundLittle is known regarding the prognostic role of Multichannel Intraluminal Impedance and pH monitoring (MII/pH) parameters in preterm infants with Gastro-Esophageal Reflux Disease (GERD).AimOur study aimed to evaluate the relationship between MII/pH variables and the duration of pharmacological therapy for GERD, in preterm infants with gestational age (GA) ≤ 34 weeks.Subjects, study design, outcome measuresWe retrospectively reviewed data of all newborns with GA ≤ 34 weeks that underwent MII/pH in our Neonatal Intensive Care Unit (NICU) and pharmacological treatment for GERD. We included them in a 12-month follow-up program. MII/pH parameters were used as independent variables and the duration of pharmacological therapy as dependent variable in linear regression models.Results16 patients (GA 28.4 ± 1.8 weeks, BW 1122 ± 427 g) were enrolled into the study. Regression analysis performed on all reflux events reported a significant correlation between the duration of pharmacological treatment and MII-BEI (r² = 0.36, p = 0.01) and MII-reflux frequency (r² = 0.33, p = 0.02). Moreover, regression analysis performed on all events classified according to the corresponding pH change – acidic (ac.), weakly acidic (w.ac.) or weakly alkaline (w.a.) – showed a significant correlation between the duration of pharmacological treatment and MII-w.ac.BEI (r² = 0.26, p = 0.05), MII-w.ac. reflux frequency (r² = 0.44, p = 0.01), and MII-proximal w.ac. reflux frequency (r² = 0.35, p = 0.02). No statistically significant correlation was found between pH-Reflux Index and the duration of treatment.ConclusionThe study shows how, in our population of preterm infants, MII-parameters could have not only a diagnostic role, but also a prognostic value in terms of the duration of pharmacological treatment.     

Safety and one-year efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy

BackgroundProspective studies that address both efficacy and safety of continuous infusion of intrathecal baclofen (CITB) in children with spastic cerebral palsy (CP), and that use outcome measures beyond muscle tone are lacking.AimsTo study the efficacy at 12 months and safety up to 24 months after start of CITB in children with intractable spastic CP.MethodsNine girls and eight boys, aged 13.7 years (SD 2.9), received a SynchroMed pump for CITB. We prospectively recorded effects and adverse events at regular follow-up visits up to 24 months. Outcome measures included the 0–10 visual analogue scale (VAS) for individual problems, Gross Motor Function Measure (GMFM) and health related quality of life as measured with the Child Health Questionnaire-PF50.ResultsCITB for 12 months significantly improved the VAS for individual problems with 4.7 (SD 2.0; p = 0.000), VAS for ease of care with 5.2 (SD 2.1; p = 0.000), VAS for pain with 5.4 (SD 2.7; p = 0.002); GMFM sitting dimension with 3.3 (range ?4.0 to 22.0; p = 0.022), GMFM goal dimension with 4.0 (range 0.0–26.0; p = 0.007); and Child Health Questionnaire-PF50 domains of bodily pain/discomfort with 25.6 (SD 35.9; p = 0.016) and mental health with 9.8 (SD 11.3; p = 0.007). During a mean follow-up of 18.4 months (range 12–24), we recorded 80 adverse events. Eight adverse events were serious, but not life-threatening.ConclusionsCITB was effective at 12 months and safe up to 24 months for carefully selected children with intractable spastic CP. CITB relieved pain, facilitated ease of care and improved mental health. The majority of children could extend their activities and participation.     

Prevalence of metabolic syndrome-like in the follow-up of very low birth weight preterm infants and associated factors

ObjectiveTo assess the prevalence of metabolic syndrome-like symptoms in a population of preterm infants with very low birth weight (<1500 g) at 2 years of corrected age and identify the occurrence of associated risk factors.MethodsCross-sectional study during a five-year period, including preterm infants born with very low birth weight evaluated at 2 years of corrected age. Metabolic syndrome-like symptoms was defined by the presence of three or more of these criteria: abdominal circumference ≥ 90th percentile, fasting blood glucose ≥ 100 mg/dL, triglycerides ≥ 110 mg/dL, HDL cholesterol ≤ 40 mg/dL, and blood pressure ≥ 90th percentile.ResultsA total of 214 preterm infants with birth weight < 1500 g were evaluated. The prevalence of metabolic syndrome-like symptoms at 2 years of corrected age was 15.1%. Arterial hypertension was present in 57.5%, HDL ≤ 40 mg/dL in 29.2%, hypertriglyceridemia in 22.6%, and abdominal circumference above the 90th percentile in 18.8%. Only 3.7% had hyperglycemia. The presence of periventricular leukomalacia was an independent risk factor for arterial hypertension at this age (OR 2.34, 95% CI: 0.079–0.69, p = 0.008). Overweight and obesity at 2 years of corrected age were independently associated with metabolic syndrome-like symptoms (OR 2.75, 95% CI: 1.19–6.36, p = 0.018).ConclusionMetabolic syndrome-like symptoms can be observed in very low birth weight preterm infants as early as 2 years of corrected age. Overweight and early-onset obesity are significant risk factors for metabolic syndrome-like symptoms, which deserves appropriate intervention for this high-risk population.     

Vitamin D deficiency at pediatric intensive care admission

Objectiveto assess whether 25hydroxivitaminD or 25(OH)vitD deficiency has a high prevalence at pediatric intensive care unit (PICU) admission, and whether it is associated with increased prediction of mortality risk scores.Methodprospective observational study comparing 25(OH)vitD levels measured in 156 patients during the 12 hours after critical care admission with the 25(OH)vitD levels of 289 healthy children. 25(OH)vitD levels were also compared between PICU patients with pediatric risk of mortality III (PRISM III) or pediatric index of mortality 2 (PIM 2) > p75 [(group A; n = 33) vs. the others (group B; n = 123)]. Vitamin D deficiency was defined as < 20 ng/mL levels.Resultsmedian (p25‐p75) 25(OH)vitD level was 26.0 ng/mL (19.2‐35.8) in PICU patients vs. 30.5 ng/mL (23.2‐38.6) in healthy children (p = 0.007). The prevalence of 25(OH)vitD < 20 ng/mL was 29.5% (95% CI: 22.0‐37.0) vs. 15.6% (95% CI: 12.2‐20.0) (p = 0.01). Pediatric intensive care patients presented an odds ratio (OR) for hypovitaminosis D of 2.26 (CI 95%: 1.41‐3.61). 25(OH)vitD levels were 25.4 ng/mL (CI 95%: 15.5‐36.0) in group A vs. 26.6 ng/mL (CI 95%: 19.3‐35.5) in group B (p = 0.800).Conclusionshypovitaminosis D incidence was high in PICU patients. Hypovitaminosis D was not associated with higher prediction of risk mortality scores.     

Maternal breastfeeding: indicators and factors associated with exclusive breastfeeding in a subnormal urban cluster assisted by the Family Health Strategy

ObjectiveTo describe and analyze indicators of feeding practices related to breastfeeding and factors associated with exclusive breastfeeding (EBF) in a subnormal urban cluster (slums) in Pernambuco, Brazil.MethodsFour breastfeeding indicators were used to interview mothers of children under 3 years of age. An inventory of the families’ socioeconomic and environmental factors, maternal obstetric history, and basic health care access was undertaken. The sample consisted of all 310 children under the age of 3 years from Coelhos, PE, Brazil. Spearman's correlation was carried out, as well as crude and adjusted prevalence ratios for a final statistical model that showed associated factors with the main outcome at a level of 0.05.ResultsThe prevalence of breastfeeding in the first hour of life, exclusive breastfeeding up to 6 months, continued breastfeeding at 1 year, and continued breastfeeding at 2 years were 60.2%, 32.9%, 45.9, and 35.9%, respectively. A correlation was observed between start of pacifier use and duration of either exclusive (r_s = 0.358 [p < 0.001]) or non-exclusive breastfeeding (r_s = 0.248 [p = 0.006]). Maternal age over 35 years (p < 0.001), home visit in the first week after birth (p = 0.003), having had a male baby (p = 0.029), and not using a pacifier (p < 0.001) remained protective factors in the final model.ConclusionThe prevalence rates of exclusive breastfeeding at 6 months were well above the results obtained by other Brazilian authors. Home visit and maternal age prevailed as protective factors, while pacifier use was shown to be a discouraging practice.     

¿Qué variables influyen en el cumplimiento de las recomendaciones de actividad física en preescolares?

IntroductionThere are established European guidelines for physical activity in childhood. The main goal of our study was to determine the factors that may influence compliance with European recommendations for physical activity in young children.MethodsWe included 136 children (aged 2-8 years) classified by weight status, calculated based on the body mass index z-score using the growth standards of the World Health Organization. We measured physical activity over 5 consecutive days with accelerometers and recorded the food intake.ResultsA greater level of physical activity was associated with a lower weight status category (B = −1.55; 95% CI: −2.02 to −1.08; P < .001), lower age (B = −1.33; 95% CI: −1.72 to −0.93; P < .001) and greater energy expenditure (B = 0.02; 95% CI: 0.02 to 0.03; P < .001). The overall physical activity in the sample was light (mean = 589 cpm/day). Children with overweight and obesity spent less time engaged in moderate to vigorous physical activity (P = .005) and more time engaged in sedentary activities (P = .005) compared to children with normal weight. All groups spent between 90 and 130 minutes a day in sedentary activities, with a mean time spent that amounted to 15.5% of their time (excluding time spent sleeping). The adherence to European recommendations varied in association with sex (P = .010) and weight status (P = .038).ConclusionYoung children spent more than 100 minutes a day engaged in sedentary activities. Most of the sample met the European recommendations for daily moderate to vigorous physical activity. However, the degree of adherence depended on sex and weight status.     

Evaluation of functional capacity for exercise in children and adolescents with sickle-cell disease through the six-minute walk test

ObjectiveTo evaluate lung functional capacity (FC) for physical exercise in children and adolescents with sickle cell disease (SCD) through the six-minute walk test (6MWT).MethodA cross-sectional prospective study was performed to evaluate the FC of 46 patients with SCD through the 6MWT. The following parameters were assessed: heart rate (HR), respiratory rate (RR), peripheral pulse oxygen saturation (SpO₂), peak expiratory flow (PEF), blood pressure (systolic and diastolic), dyspnea, and leg fatigue (modified Borg scale) at rest, in the end of the test, and ten minutes after the 6MWT. The total distance walked was also recorded. For statistical analysis, the parametric variables were analyzed using the paired Student's t-test, analysis of variance (ANOVA), and Bonferroni multiple comparisons, with a significance level set at p ≤ 0.05.ResultsThe 46 patients were aged age 9.15 ± 3.06 years, presented baseline Hb of 9.49 ± 1.67 g/dL, and walked 480.89 ± 68.70 m. SCD diagnosis was as follows: group 1- HbSS (n = 20)/HbSβ⁰-thalassemia (n = 3) and group 2 - HbSC (n = 20)/HbSβ⁺-thalassemia (n = 3). Regarding total distance walked, patients in group 1 walked a shorter distance than patients in group 2 (459.39 ± 57.19 vs. 502.39 ± 73.60 m; p = 0.032). There was no statistical difference regarding PEF in the three moments of evaluation. The SpO₂ in ambient air and SpO₂ with O₂ differed between groups 1 and 2 (p < 0.001 vs. p = 0.002), as well as the RR (p = 0.001).ConclusionThese patients showed a lower FC for exercise than that predicted for the age range in the literature. Patients diagnosed with HbSS/Sβ0-thalassemia had a lower performance in the test than those with HbSC/Sβ⁺-thalassemia regarding total distance walked, RR, and SpO₂ after the 6MWT.     

Intra-abdominal fat measurement by ultrasonography: association with anthropometry and metabolic syndrome in adolescents

ObjectiveTo associate intra-abdominal fat thickness measured by ultrasonography to the factors related to metabolic syndrome and to determine cutoff points of intra-abdominal fat measurement associated with a greater chance of metabolic syndrome in adolescents.MethodsThis was a cross-sectional study, with 423 adolescents from public schools. Intra-abdominal fat was measured by ultrasonography. Anthropometric data were collected, and biochemical analyses were performed.ResultsIntra-abdominal fat was measured by ultrasonography, showing a statistically significant association with the diagnosis of metabolic syndrome (p = 0.037), body mass index (p < 0.001), elevated triglyceride levels (p = 0.012), decreased plasma HDL levels (p = 0.034), and increased systemic blood pressure values (p = 0.023). Cutoff values of intra-abdominal fat thickness measurements were calculated by ultrasound to estimate the individuals most likely to develop metabolic syndrome. In the logistic regression models, the cutoff values that showed the highest association with metabolic syndrome in males were 4.50, 5.35, 5.46, 6.24, and 6.50 cm for the ages of 14, 15, 16, 17, and 18/19 years, respectively. In the female gender, the cutoff values defined for the same age groups were 4.46, 4.55, 4.45, 4.90, and 6.46 cm. In an overall analysis using the ROC curve, without gender and age stratification, the cut-off of 3.67 cm showed good sensitivity, but low specificity.ConclusionUltrasonography is a useful method to estimate intra-abdominal adipose tissue in adolescents, which is associated with the main factors related to obesity and metabolic syndrome.     

Evaluation of GLUT1, IGF-2, VEGF,FGF 1, and angiopoietin 2 in infantile hemangioma

IntroductionInfantile hemangioma (IH) is a common vascular tumor in children. It is reported that IHs are associated with immunochemical markers such as vascular endothelial growth factor (VEGF)-A, glucose transporter isoform 1 (GLUT1), and insulin-like growth factor-2 (IGF-2).Material and methodsThis cross-sectional study focused on pediatric patients with IH. A total of 46 patients (mean age 14.2 ± 21.9 months) with IH and 45 healthy controls (mean age 21.8 ± 15.08 months) were enrolled. Demographic data, clinical findings, and laboratory parameters were recorded. Blood samples were collected. Serum GLUT1, IGF-2, VEGF-A, fibroblast growth factor 1 (FGF1), and angiopoietin 2 levels were assessed by enzyme-linked immunosorbent assay.ResultsSerum GLUT1, IGF-2, and VEGF-A levels were significantly higher in patients with IH than in healthy controls (8.80 ± 4.07 pg/mL vs. 5.66 ± 4.34 pg/mL, 281.10 ± 84.12 pg/mL vs. 234.19 ± 75.38 pg/mL, 1196.99 ± 389.34 pg/mL vs. 996.99 ± 349.16 pg/mL, respectively, p = 0.026, p = 0.030, and p = 0.036). Serum GLUT1, IGF-2, and VEGF-A levels in patients with complicated hemangioma were significantly higher than in healthy controls (9.69 ± 3.94 pg/mL vs. 5.66 ± 4.34 pg/mL, 289.94 ± 83.18 pg/mL vs. 234.19 ± 75.38 pg/mL, 1276.22 ± 388.24 pg/mL vs. 996.99 ± 349.16 pg/mL, respectively, p = 0.017, p = 0.022, and p = 0.011). Serum GLUT1, IGF-2, and VEGF-A levels in patients with hemangioma receiving propranolol treatment were significantly higher than in healthy controls. Serum FGF1 levels were higher in patients with IH, complicated hemangioma, and hemangioma receiving propranolol treatment than in healthy controls but the difference was not statistically significantly.ConclusionSerum GLUT1, IGF-2, and VEGF-A levels were positively correlated with disease severity in patients with hemangioma, for example, in complicated hemangioma and hemangioma requiring propranolol treatment. However, further research on larger and different age subgroups is warranted to assess these markers.     

Botulinum toxin type A treatment in children with cerebral palsy: Evaluation of treatment success or failure by means of goal attainment scaling

BackgroundThere is considerable variability in the amount of response to BTX-A treatment between and within patients with cerebral palsy (CP).AimsThe purpose of this retrospective cohort study was to evaluate the clinical responsiveness of Botulinum toxin type A (BTX-A) treatment in children with CP and specifically delineate features of treatment success and failure.MethodsFour hundred and thirty-eight children (251 boys, 187 girls; mean age 8 years 2 months, SD 4 years) were included into the study. Goal Attainment Scaling (GAS) was used to classify and evaluate treatment efficacy. Two study groups were defined: one group with an excellent response (GAS ≥ 60.0) and one group with a lack of response (GAS ≤ 40.0) to BTX-A.ResultsSeventy-five patients (17.1%) had an excellent response and treatment was found to be unsuccessful for 31 patients (7.1%). Children with a lack of response to BTX-A were significantly older compared to children with a high responsiveness (p = 0.0013). In the latter group, more children received multi-level injections and fewer children had injections in proximal parts of the lower limb compared to the low responsiveness group (p = 0.0024). Moreover, there was a significant difference in the use of different types of casts between both study groups (p = 0.0263).ConclusionAge, level of treatment and casting seem to be crucial features of BTX-A treatment success or failure in children with CP.     

Oxidative and antioxidative status of children with acute bronchiolitis

ObjectiveOxidative stress has been shown to contribute to the pathogenesis of acute and chronic lung inflammatory diseases. This article aimed to evaluate the oxidant/antioxidant status of children with acute bronchiolitis through the measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index.MethodsChildren with acute bronchiolitis admitted to the pediatric emergency department of a university hospital between January and April of 2012 were compared with age-matched healthy controls. Patients with acute bronchiolitis were classified as mild and moderate bronchiolitis. Oxidative and antioxidative status were assessed by measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index.ResultsThirty-one children with acute bronchiolitis aged between 3 months and 2 years, and 39 healthy children were included. Total oxidative status (TOS) was higher in patients with acute bronchiolitis than the control group (5.16 ± 1.99 μmol H₂O₂ versus 3.78 ± 1.78 μmol H₂O₂ [p = 0.004]). Total antioxidant capacity (TAC) was lower in children with bronchiolitis than the control group (2.51 ± 0.37 μmol Trolox eqv/L versus 2.75 ± 0.39 μmol Trolox eqv/L [p = 0.013]). Patients with moderate bronchiolitis presented higher TOS levels than those with mild bronchiolitis and the control group (p = 0.03, p < 0.001, respectively). Patients with moderate bronchiolitis had higher oxidative stress index levels than the control group (p = 0.015). Oxygen saturation level of bronchiolitis patients was inversely correlated with TOS (r = ?0.476, p < 0.05).ConclusionThe balance between oxidant and antioxidant systems is disrupted in children with moderate bronchiolitis, which indicates that this stress factor may have a role in the pathogenesis of the disease.     

The role of the thalamus in neuro-cognitive dysfunction in early unilateral hemispheric injury: A multimodality imaging study of children with Sturge–Weber syndrome

BackgroundSturge–Weber syndrome (SWS) with unilateral hemispheric involvement is a clinical model of early onset, chronic, often progressive hemispheric injury, resulting in variable neuro-cognitive impairment.AimsTo evaluate if abnormal diffusion and metabolism of the thalamus, a central relay station with extensive cortical connections, may serve as a simple imaging marker of neuro-cognitive dysfunction in SWS.MethodsWe obtained both diffusion tensor imaging and FDG PET in 20 children (11 girls; age range: 3–12.4 years) with unilateral SWS. Diffusion parameters as well as FDG uptake were measured in thalami, compared to normal control values, and correlated with the extent of cortical hypometabolism, deep venous abnormalities and cognitive (IQ) as well as fine motor functions.ResultsChildren with SWS had significantly higher thalamic glucose metabolic asymmetry than controls (p = 0.001). Thalamic metabolic asymmetries correlated positively with the asymmetry of thalamic diffusivity (p = 0.001) and also with the extent of cortical hypometabolism (p < 0.001). Severe thalamic asymmetries of glucose metabolism and diffusion were strong predictors of low IQ (metabolism: p = 0.002; diffusivity: p = 0.01), even after controlling for age and extent of cortical glucose hypometabolism in children with left hemispheric involvement. Ipsilateral thalamic glucose hypometabolism was also associated with impairment of fine motor functions (p = 0.002).ConclusionsBoth diffusion and glucose metabolic abnormalities of the thalamus are closely related to cognitive functions, independent of age and cortical metabolic abnormalities, in children with unilateral SWS. Thalamic metabolic asymmetry is a robust but simple imaging marker of neuro-cognitive outcome in children with early unilateral hemispheric injury caused by Sturge–Weber syndrome.     

Oxidant-antioxidant status in Egyptian children with sickle cell anemia: a single center based study

Objectivethe present study was conducted to investigate the oxidant-antioxidant status in Egyptian children with sickle cell anemia.Methodsthe serum levels of total antioxidant capacity (TAO), paraoxonase (PON), vitamin E, nitrite, and malondialdehyde (MDA) were measured in 40 steady state children with homozygous sickle cell anemia (24 males and 16 females) and 20 apparently healthy age- and gender-matched controls.Resultsmean serum TAO, PON, vitamin E, and nitrite levels were significantly lower in the group with sickle cell anemia, whereas mean serum MDA was significantly higher in these children compared to controls. No significant differences in mean levels of TAO, PON, nitrite, vitamin E, and MDA were found in sickle cell anemia patients receiving hydroxyurea when compared with those not receiving hydroxyurea. A significant negative correlation between serum nitrite and the occurrence of vaso-occlusive crises (VOC) was observed (r = −0.3, p = 0.04). PON level was found to be positively correlated with patients’ weight and BMI (r = −0.4, p = 0.01; r = −0.7, p < 0.001, respectively), but not with frequency of VOC. The area under the curve of serum nitrite in predicting occurrence of VOC was 0.782, versus 0.701 for PON, and 0.650 for TAO (p = 0.006). Serum MDA was not correlated with nitrite, PON, TAO, or vitamin E levels. No significant correlations were detected between serum nitrite and hemoglobin or antioxidant enzymes.Conclusionchildren with sickle cell anemia have chronic oxidative stress that may result in increased VOC, and decreased serum nitrite may be associated with increases in VOC frequency. A novel finding in this study is the decrease in PON level in these patients, which is an interesting subject for further research.     

Efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy: A randomised controlled trial

BackgroundIntractable spasticity can be treated effectively with continuous infusion of intrathecal baclofen. Because evidence for its use in the treatment of children with spastic cerebral palsy is lacking, we conducted a randomised controlled trial.AimsTo test whether continuous infusion of intrathecal baclofen is effective in comparison with standard treatment only.MethodsSeventeen children, aged 13.2 (SD 2.8) years, with intractable spastic cerebral palsy were randomised to receive a Synchromed pump for continuous infusion of intrathecal baclofen after either 1 month (CITB group) or 6 months (Control group). Primary outcomes were the 6-month-change scores on the 0–10 visual analogue scale for individually formulated problems and the caregiver assistance scale of the Pediatric Evaluation of Disability Inventory self-care domain. One of the secondary outcome measures was health related quality of life as measured with the Child Health Questionnaire-PF50.ResultsNine children were randomly assigned to the CITB group and eight to the Control group. The visual analogue scale for individual problems improved with 4.0 (SD 1.7) in the CITB group and changed with ?0.2 (SD 1.3) in the Control group (p = 0.001). Pediatric Evaluation of Disability Inventory scores did not change significantly. The Child Health Questionnaire-PF50 6-month-change score significantly differed in favour of the CITB group for the domains of bodily pain/discomfort (p = 0.014), mental health (p = 0.045), psychosocial status (p = 0.027) and parents' personal time limitation (p = 0.043).ConclusionThe results of this randomised controlled trial establish continuous infusion of intrathecal baclofen to be effective in carefully selected children with problems caused by intractable spastic cerebral palsy.     

Insulin resistance in obese children and adolescents

ObjectiveTo evaluate the presence of insulin resistance and its association with other metabolic abnormalities in obese children and adolescents.MethodsRetrospective study of 220 children and adolescents aged 5-14 years. Anthropometric measurements were performed (weight, height, and waist circumference) and clinical (gender, age, pubertal stage, and degree of obesity) and biochemical (glucose, insulin, total cholesterol, and fractions, triglycerides) data were analyzed. Insulin resistance was identified by the homeostasis model assessment for insulin resistance (HOMA-IR) index. The analysis of the differences between the variables of interest and the HOMA-IR quartiles was performed by ANOVA or Kruskal-Wallis tests.ResultsInsulin resistance was diagnosed in 33.20% of the sample. It was associated with low levels of high-density lipoprotein cholesterol (HDL-C; p = 0.044), waist circumference measurement (p = 0.030), and the set of clinical and metabolic (p = 0.000) alterations. Insulin-resistant individuals had higher mean age (p = 0.000), body mass index (BMI; p = 0.000), abdominal circumference (p = 0.000), median triglycerides (p = 0.001), total cholesterol (p ≤ 0.042), and low-density lipoprotein cholesterol (LDL–C; p ≤ 0.027); and lower HDL-C levels (p = 0.005). There was an increase in mean BMI (p = 0.000), abdominal circumference (p = 0.000), and median triglycerides (p = 0.002) as the values of HOMA -IR increased, with the exception of HDL-C, which decreased (p = 0.001). Those with the highest number of simultaneous alterations were between the second and third quartiles of the HOMA–IR index (p = 0.000).ConclusionThe results confirmed that insulin resistance is present in many obese children and adolescents, and that this condition is associated with alterations that represent an increased risk for developing metabolic disorders in adulthood.